Hemodynamic Responses to Laryngoscopy and Tracheal Intubation

Effectiveness of Intravenous Ketodex Versus Ketofol for Obtunding Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Adult Elective Middle Ear Surgery Patients: A Prospective Randomized Comparative Study

Laryngoscopy and tracheal intubation lead to tachycardia and hypertension due to increase in the plasma catecholamines subsequent to sympathetic stimulation.

Various prophylactic interventions have been tried to blunt the hemodynamic stress response to laryngoscopy and tracheal intubation. The ketamine-dexmedetomidine combination (ketodex) and ketamine-propofol combination (ketofol) may be of benefit in maintaining hemodynamic stability and reducing potential side effects of each drug.

Inclusion Criteria:

• Adult patients scheduled for elective middle ear surgery under general anesthesia, ASA status I-II, aged from 18 to 60 years old of either sex.

Exclusion Criteria:

• Full stomach or emergency surgery
• Any known contraindications or allergy to ketamine, dexmedetomidine, or propofol
• Pregnancy or breastfeeding women
• Body mass index (BMI) > 35 Kg/m2
• History of hepatic, renal, or cardiac disease
• Patients in whom the duration of laryngoscopy will last more than 25 seconds
• Chronic opioid use, or history of neuropsychiatric disorders
• Patient refusal